21 Disease of Skin Appendages

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CHAPTER XXI

DISEASES OF SKIN APPENDAGES

(SEBACEOUS GLANDS, HAIR, NAILS)

Among the diseases of the sebaceous glands are the most important seborrhoea and various

types of acne (acne), developing on its background.Among them are the main form of acneordinary, which determine the number of varieties. In addition, there are necrotic acne,

acne keloid, acne neonatorum, medicines, as well as acne rosacea (rosacea).

Seborrhea

Seborrhea - a disease caused by saloobrazovaniya disorder, manifested an enhanced

secretory activity of sebaceous glands and changes in the chemical composition of sebum.

Etiology and Pathogenesis of seborrhea insufficiently clear.Antibacterial properties of the skingarden suppressed as a result of changes in the secretion of sebaceous glands, which in turn

creates the conditions for the reproduction and transformation of saprophytic microflora in the

pathogenic flora.Number of sebum and its qualitative characteristics depend on the generalcondition of the body (especially the endocrine and nervous system, digestive tract) sex and age,

diet patterns, associated diseases, etc.The greatest number of sebum produced and released

during puberty.In the elderly, its quantity is greatly reduced.Frustration secretion of sebumusually occurs as a result of violations of the physiological balance between estrogen and

androgen hormones in the direction of the latter, which often occurs between the ages of 14 to 25

years.When seborrhea changing the composition of sebum is mainly due to increase in the

content of its free fatty acids.

The characteristic histological signs of seborrhea are hyperkeratosis, reduced papillary dermis,

hypertrophy of the sebaceous glands, the inflammatory infiltrate limfogistiotsitarny around skin

appendages and blood vessels.As a result of increased keratinization difficult selection secretplace atrophy and loss of sebaceous glands and hair papillae, develops perifollikulyarnaya

hyperplasia of connective tissue. To a greater extent, such changes are expressed in the thick

greasy seborrhea and less - in its liquid variety.In the dry form of the leading pathologicalchanges are follicular hyperkeratosis and not enough development of tallow-hair unit.

Clinical picture.Allocate seborrheafat (thick and liquid), and dry mixed.The most pronouncedmanifestation of seborrhea of the skin in areas where sebaceous glands are located in large

numbers: the face, scalp, chest and back. Thick oily seborrhea is characterized by thickening

and decreased elasticity of the skin, brownish-gray color of its significant expansion of the

mouths of the sebaceous glands.Often, the excretory duct cancer clogged rejected by epithelialcells, revitalized skin fat. So there comedo (comedo) - horn tube, or if this item squeeze, then

released a dense mass of tallow.In this form of seborrhea quite common atheroma - atheroma.Inthe case of inflammation of atheroma are her autopsy, pyorrhea and scar formation. In the thick


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form of oily seborrhea hair brutally.Of the complications encountered in this form of the diseasein the first place it should be noted secondary pyoderma: boils abscesses, folliculitis.

When the liquid oily seborrhea skin is shiny, like orange peel (pores widened gape) of theextended duct of sebaceous glands in the excess allocated sebum. The hair on his head look like

a greased, glued together into strands.

At the hair more or less densely sit quite abundant yellowish scales.Perhaps the development ofbaldness. In this form of the disease as a result of changes in the chemical composition of sebum

is losing its inherent sterilizing properties, leading to the accession of secondary infection and the

development of pyoderma: folliculitis, furuncles, sycosis, impetigo, etc.

When dry seborrhea sebaceous excretions decreased, horny scales almost completely cover the

scalp and hair.The development of this process is associated with activation of the agent -

Pityrosporum ovale.Desquamation develops, usually in the occipital-parietal region, or across

the surface of the scalp.Flakes easily separated, contaminate the hair falling on clothing

(dandruff).The hair is usually dry, thin and brittle, with split ends. In this form of the disease onthe skin extensor surfaces of the limbs and sides of the torso can be expressed in follicular

keratosis, in addition, the skin may appear pink or reddish spots of color, covered with small

scales - seboreidy.From the subjective feeling sick note a sense of contraction of the skin, a little

itching, increased after washing (especially cold water).When mixed seborrhea skin in midface(forehead, nose, chin) fat, and on the cheeks - dry and in the frontal and parietal areas of

sebaceous excretions dramatically enhanced, and the rest the head surface is moderately

expressed, or reduced.Perhaps the presence of mixed forms of oily seborrhea: on the face of

pronounced symptoms of the liquid, and on the scalp - a thick oily seborrhea.The diagnosis of

seborrhea is on the basis of clinical picture.In doubtful cases the differential diagnosis spend

with seborrheic eczema, psoriasis.

Treatment includes dieting: restricting carbohydrates, animal fats, salt, extractives.Food should

be rich in fiber, vitamins, dairy products.Need to identify and possibly eliminate pathogenicfactors contributing to prolonged and persistent course of disease (abnormalities in the

autonomic nervous system, gastrointestinal tract, liver, foci of chronic infection).Recommended

anti-androgenic drugs that can inhibit the release of sebum.Thus, a contraceptive drug "Diana",

which has anti-androgenic properties, is used in the treatment of oily seborrhea.He appointed

women to 1 tablet per day, starting with a 5-day periods, within 21 days.Then, after a 7-day

break, resume treatment and conduct courses for 3-5 months.Men medication prescribed cycles

of 10 days with 20-day intervals.Applied also vitamins A, C, E, Group B, trace elements (sulfur,iron, phosphorus, etc.).Local for oily seborrhea use alcohol solutions containing resorcinol (2-5%), salicylic acid (2-3%), boric acid, sulfur ("milk" Vidal), when dry seborrhea - sulfur 5-10%),

salicylic ( 1.5%) ointment, creams containing vitamins A, E and F. In order to combat dandruff

creams are used as "special," Paprin "lotion" Nolan ", Shampoo" Seborin, "Head End shouldez ','

Nizoral ", 2,5% sulsenovuyu paste or soap (for oily and dry seborrhea).

Acne Ordinary


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Common Acne (Acne vulgaris; blues. Blackheads Youth) - a chronic, often relapsing

purulent inflammation of the sebaceous glands.

Etiology and pathogenesis.Favorable background condition for the development of acne is

usually seborrhea.Increased sebaceous excretions, developed primarily due to increased

concentrations of androgens and / or lowering of blood androgensvyazyvayuschego protein,leads to keratinization mouths and ducts of sebaceous glands, hypertrophy of the sebaceous

glands and the appearance of comedones - black eels.Stagnant sebum in the blocked sebaceousglands can be expanded, as a good nutrient medium for diverse microflora (predominantly

coccal, corynebacteria, propionbaktery), which forms a clinical picture of acne.Developmentvulgar acne contribute genetic predisposition, abnormalities of endocrine glands, the pathology

of the digestive tract, vitamin deficiencies, violations of the diet (consumption of excessive

amounts of fat, carbohydrates, irritating food).

Clinical picture.For vulgar acne is characterized by comedones, papules, pustular elements, thesuperficial and deep follicular pustules confined to the excretory ducts of the sebaceous glands,

opening the mouth of the follicles.In typical cases around the comedo develops an inflammatoryreaction, clinically manifested by a conical or hemispherical follicular papules red or purple-

bluish color in the center of which there is a small pustule (pimplespapulopustuleznye). Inflammation can be localized at different depths, and thus its locationemit indurative acne (extensive infiltrates with lumpy surface) and the acne abscess (deep, slow

growing or follicular perifollikulyarnye cold dermo-gipodermalnye abscesses).In severe cases of

acne may merge (blackheads drain).The sebaceous glands continue to provide sebum, which,having no outlet, fills and stretches the sebaceous glands and ducts. So formed atheroma -

retention cysts.They can become inflamed and suppurate, forming deep purplish-bluish knots

color.Clinical picture of acne often complement whiteheads - whitehead.They are dense knots

of milky-white, as if ingrained in the skin in the form of sago grains - retention cysts superficialsebaceous glands.With the evolution of acne usually occurs with the opening of the elements ofalienation of the pus and the subsequent formation of scars of various sizes and forms. Necrotic

acne - a special type of acne, in which deep in the follicle develops necrosis.It is believed that

their development is due to streptococcus, which increased the sensitivity of the organism.At thetop there is an element of acne pustule with hemorrhagic content, then formed a scab and

scar.Such eruptions are often on the skin of the forehead and temples.Are sick more often menaged 30-50 years.

A special form of acne is acne keloid(papillary dermatitis of the head, neck sclerosing

folliculitis), which occurs in men aged 20-40 years in the neck and the back of the neck.This

group of small follicular papules located in a strand, the skin around them abruptly sealed.Itcreates the appearance of a papillary tumor (due to a significant increase in skin furrows). Thehair on these sites are growing in tufts. These elements are not ulcerate, and in their resolution

remain keloid scars. The most severe kind ofacne are konglobatnye (spherical), which are

located in deep layers of the proper skin and subcutaneous fat.They are large in size, with amassive infiltration of the rough surface at the opening of pustules formed a fistula, which then


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heal scar peculiar mostikoobraznymi. This rash is usually located in groups of several elements

at various seborrheic areas, mainly on the neck and back.

Diagnosis is based on the clinical picture.To confirm the diagnosis, you can use the results of

pathohistological investigation.Differential diagnosis spend with pustular rosacea, pustular

ugrevidnym syphiloderm.

Treatment includes antibacterials, drugs that reduce the secretion of the sebaceous glands and

normalize keratinization of the follicle.Antibiotics, aromatic retinoids, anti-androgenic

drugs.Because antibiotics are most effective drugs tetracycline, erythromycin.They areappointed for one million U / day monthly cycles with 1-2 month intervals, or gradually reducing

the dose to 500-250 U / day for several weeks.For prevention of candidiasis receiving antibiotic

therapy combined with nystatin 500 000 units 3 times a day. In severe forms of vulgar acne,including konglobatnye, appoint roakkutan - aromatic retinoids with specific antiseboreynym

(anti-inflammatory and involutive effect on sebaceous glands), the influence of mean daily dose

0.5 mg / kg per day.Course of treatment 2-3 months, and subsequent maintenance therapy for 2-

3 months.Of the anti-androgenic drugs used oral contraceptive "Diana." A long course of acneand severe clinical manifestations of her appointed as an immunomodulating (dekaris - 150 mg 2

times a week for 3 months) and antimicrobial agents (metronidazole, the first 3 weeks of 1 tablet

4 times a day, then 2 weeks on 1 tablet 3 times a day and 2 weeks on 1 tablet 2 times a

day).After an interval of 7 days treatment should be continued another 4 weeks: the first two - 1

tablet 3 times a day, last - 1 tablet 2 times a day.Among the drugs that have anti-androgenic

properties, are also tsiproteronatsetat and spironolactone (veroshpiron).They prescribe a dose of

100 mg / day, gradually reducing it to 50-10 mg / day; treatment 2-3 months.Women treatment

is carried out from 5 th to 14 th day of the menstrual cycle.They are also used vitamin (A, C, E,group B), trace elements (sulfur, phosphorus, iron), physiotherapy techniques: UV-irradiation

(total and local), electrocoagulation pustules, electrophoresis of various drugs (antifagin, zincsulphate, and ichthyol etc.), cryotherapy (focal cryomassage liquid nitrogen or cryodestruction

individual elements). Local - rubbing the skin degreasing and disinfectants and antibiotics (4.1%

lotion with tetracycline, erythromycin, clindamycin lotion "Zener" containing erythromycin andzinc gel Dalatsin T-containing klindamiiina phosphate), sulfur, resorcinol (2%), salicylic acid (2-

5%), milk Vidal, retinoic acid (0,01-0,05% gel or cream).

Prevention is the timely treatment of oily seborrhea, sanitary maintenance of the skin. Weather

favorable.

Acne neonatorum

Acne Newborn (syn. acne estrogen) appear in the first 3-5 months of life, as a reaction of

small superficial sebaceous glands of neonatal sex hormones on the mother.

The rash usually few, are open and closed (whitehead) comedones, small pustules papules and

with little inflammation around the rim.The elements are isolated, localized on the skin of the


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cheeks, forehead, nose, nososchechnyh and nasolabial folds, on the back of the head, sometimes

on the skin of the penis.Differentiates itself from oil folliculitis.

Medication is usually not required.The rash within a few days, sometimes 2-3 per week, self-

settled.

Acne OIL

Acne Oil (syn. folliculitis oil) - the defeat of the follicular apparatus, which occurs when

prolonged contact (often a professional nature) with lubricating oils or greasy overalls.

Occurs predominantly in men (more often in dark man with thick hair). In the pathogenesis of

great importance to have a mechanical (oil clogging the secretory ducts of sebaceous glands) and

chemical (irritant oils in combination with changes in the properties of sebum) factors.The rashlocated primarily on razgpbatelnyh surfaces of the forearms, abdomen, thighs, shins.

The clinical picture is characterized by multiple follicular comedones and inflammatory acnedeveloping in the case of joining a secondary staph infection. Dermatosis characterized sluggish

flow and lack of subjective symptoms (in the absence of secondary infection). Termination of

exposure to occupational hazards and compliance with hygiene measures leading to a rather

rapid regression of rash.

Acne MEDICINES

Medical Acne develops most often from chronic administration of drugs bromine

(bromoderma), iodine (yododerma).

Development yododermy and bromodermy linked to the irritating effect of salt iodine and

bromine compounds that are derived from the skin fat and activation piokokkovoy flora.Thecharacteristic localization of acne - face, extremities. When bromo-and yododerme formed eels

are stagnant-red, no signs of seborrhea.During the process of long-term, despite the cessation of

reception of bromine or iodine, especially in violation of renal function. Diagnosis is confirmedby the discovery of iodine or bromine in the urine.

Treatment consists in the abolition of drugs causing acne, abundant drink, detoxification therapy

(Haemodesum, reopolyglukine intravenous), topical antibacterials.

Rosacea

Pink eels (more papulopustuleznaya stage rosacea) - a chronic relapsing disease of the

skin.

Get sick more often women after menopause.


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Clinical picture.Alopecia can be a total (complete absence of hair), diffuse (a sharp thinning of

hair) and focal (absence of hair on the limited areas).

By clinical characteristics and origins distinguish congenital, symptomatic, seborrheic,

premature and Cazenave's vitiligo.

Alopecia due to congenital dysplasia ektomezodermalnoy may manifest itself as an independent

disease or may be part of a comprehensive pathology, including developmental defects as nails,

teeth, bones, endocrine system, etc. The basis of congenital alopecia is the partial or completeabsence of hair follicles (gipotrihoz). In the development of disease play an important role of

genetically caused violations of synthesis of amino acids, which leads to disruption of

keratinization of hair.The skin in the areas of thinning hair is not changed, but their own hair,thin, sparse, short, some of them break off, bristly hairs are replaced Pushkova eyebrows,

eyelashes, usually absent or greatly thinned.

Alopecia is symptomatic complications of severe common diseases: acute and chronic

infections such as syphilis and connective tissue diseases, endocrinopathies, or the result ofpoisoning, long-term cytostatic therapy and radiation. This is a consequence of toxic or

autoimmune effects on hair papillae; disease is focal, diffuse or total character.Toxic alopeciadeveloped under the influence of a number of chemicals, including in the production process, or

when taking certain medications (cytostatics, etc.).The pathological process in this case, usuallyhas a diffuse character. After termination of exposure of the chemical hair growth is restored.

Identifies several groups of diseases that can lead to scarring alopecia: fungus (infiltrative,suppurative trichophytia, crusted ringworm), bacterial (tuberculosis, syphilis, carbuncle , boil,

etc.), viral (herpes zoster, varicella); connective tissue disease (lupus erythematosus,

scleroderma).

Alopecia seborrheic - develops in about 25% of people as a complication of seborrhea, starting

usually at puberty and reaching its maximum severity for 23-25 years.The hair at the same time

become thick, glued to the strands.Hair and skin are more or less sturdy greasy yellowish

scales.Hair first fall moderately, the lifetime of new hair shorter, they become thinner, thinning,

and gradually replaced Pushkova.In a subsequent process quickly grows, sometimes there is acatastrophic loss of hair and becomes noticeable bald spot that begins at the edges of the

forehead and goes back to the back or with the crown in the direction of the forehead and neck.

Bald pate is always bordered on the nape and sides of the head of the narrow ribbon of fastseated normal hair. histologically detect small hyperkeratosis, enlargement of small vessels of

the dermis with lymphocytic infiltration around them, the expansion of the mouths of hair

follicles with the accumulation of horny masses, the thinning of their walls, degenerativechanges in the root sheaths, papillae and hair follicles, and therefore the replacement of lost hairwith new almost impossible. As a consequence, is incomplete recovery of hair is disturbed

physiological process of changing hair.

Premature Alopecia (androgenic) occurs predominantly in men, begins to appear at puberty

and is formed by 25-30 years.Development of this type of hair loss associated with a particular

action of androgen hormones, which is probably due to hereditary factors.The main clinical


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signs of premature baldness is a substitution in temporo-fronto-parietal region of long hair

gradually become thinner Pushkova, which over time is shortened and lose their

pigment.Sequence changes are usually as follows: the appearance of receding hairline in both

temporal regions should involve in the pathological process of the parietal region.Over time,gradually expanding, frontal high temple merges with other parts of bald head. Throughout the

fronto-parietal region, there are only secondary Pushkova hair, which is also easy to fallout.Histologically the early stages of the disease distinguish the focal perivascular basophilic

degeneration in the lower third of the connective tissue sheath of hair.Affected follicles

progressively decreases within a few cycles in the hair.Below wrinkled follicles initially be seenthe remnants of basophilic sclerosed connective tissue of the vagina, which will eventually

disappear. Decrease the affected follicles, which is an important sign of premature hair loss,

necessarily leads to a decrease in diameter rising from their hair.

Alopecia alopecia (baldness krugovidnoe) - Acquisition of hair loss in the form of round foci

of various sizes.In the pathogenesis of the disease are significant neuro-trophic disorders,possibly with an autoimmune component, endocrine disorders, head injuries. The process usually

localized on the scalp, but can also affect the region beard, mustache, eyebrows, eyelashes and

other areas of the skin.The foci of alopecia initially have small sizes (up to 1 cm in diameter).The skin within the chamber is usually normal, sometimes, a slight congestion, which gradually

regresses.The skin foci can see the mouth of the hair follicles.With the development of foci ofalopecia are growing on the periphery, new, merged together to form large areas of alopecia with

festoon outlines.In the circle bald centers there is a "zone of shattered hair."Her hair is pulledout easily and painlessly, at its root, they are deprived of pigment and medulla end in club-

shaped thickening of the white point.They are called "hair in the form of an exclamation

mark".Lack of "zone shattered hair" with hair "in the form of an exclamation mark" indicates

the end of the progression of the process and its transition into the stationary phase.After a few

weeks or months in the initial outbreak might resume hair growth, while at the same time it ispossible appearance of new lesions.Again, grow his hair thin and colorless at first, but graduallythey restore their structure and color.

Identify several forms of alopecia areata: 1) the total - usually begins in childhood as alopecia

areata, but notes the rapid emergence of new, merging with each other foci, which leads to acomplete loss of hair on his head, including eyebrows and eyelashes, and 2) subtotal form of

alopecia occupies about 50% of the entire surface of the head, characterized by slow progression,

the emergence of new hotbeds of maintaining Pushkova and short hair in the marginal zone and

some areas where there are thin, twisted, colorless single hairs or groups that can easily fall out

when pulling for them.Often occur outside of the eyebrow thinning and partial loss of eyelashes,

and 3) universal, characterized by loss of hair on all skin. Total alopecia. It is often combinedwith degenerative changes in the nails and accompanied by a pronounced neurotic syndromes

with vegetodistoniey 4) the boundary shape (ofiaz) - distribution of alopecia on the edge of the

scalp, usually in the neck and sideburns, and the frequently observed a temporary preservation

Pushkova hair in the marginal zone with their total precipitation in the future.


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Histologically in alopecia areata emit little hair buds, bulbs are located at shallow depth (about 2

mm from the skin surface at the rate of 3.5 mm). The hair shaft is thin, not completely

ceratinized, melanin and melanocytes from hair follicles disappear and are moved to the dermal

papilla.Around modified hair is connective tissue, blood vessels obliterans.In the early stages offiltration is bulb lymphocytes. In the old foci of reduced number of hair follicles increased, but

most of them retains the ability to form hair.Diagnosis based on clinical data.The differentialdiagnosis spend with symptomatic alopecia with mycosis (Microsporum, trichophytia), syphilis,

etc.

Treatment: prescribe psychotropic and nootropic drugs (sibazon, azafen, nootropics), vitamins

(A, E, multivitamins, including those containing microelements), Fitin, biotin,

immunomodulating drugs (dekaris, methyluracil, T-activin).In alopecia areata, other than thoselisted drugs prescribed angioprotectors (doksium) and drugs that improve the microcirculation

(trental).In severe cases, can be used corticosteroid therapy (oral or in the form obkalyvaniyacenters), but it does not guarantee against relapse of disease, aggravated by the growing steroid

atrophy of the skin.In the treatment of seborrheic alopecia and premature prescribe anti-

androgenic drugs ("Diana" and others).For all types of hair loss using d'Arsonval currents,

irrigation hdoretilom, cryomassage, UV rays.In severe cases, ultraviolet rays are useful tocombine the reception photosensitizers (ammifurin, beroksan) or conduct fotohimioterapiyu. We

also demonstrate acupuncture, including lazerorefleksoterapiya.Externally appointed annoyingrubbing alcohol (tincture of red pepper extract, Naphthalan oil), corticosteroid creams (non-

durable to avoid the development of atrophy of the skin), the drug "Rigeyn, which includes

minoxidil (with seborrheic alopecia and premature), and pilastin (cholera vaccine ) and

silokast.Rubbing pilastina in lesions but also conducts courses for 6 days (1 time per day) withan interval of 1.5 months (most effective for alopecia hair loss).The structure consists ofsilokasta Mival (Dow Corning), castor oil and Dimexidum. He smeared the affected area 1-2

times a day for several months (in all types of hair loss, except congenital),. Is essential rightshampoo (better to use boiled water , superfatted neutral soap, and rinsing, infusions anddecoctions of herbs: nettle, burdock root, chamomile, succession, celandine, St. John's wort,

etc.).When seborrheic alopecia should wash their hair 1 time in 5-7 days with other forms ofdisease treatment wash can be arbitrary. When seborrheic alopecia and premature advisable to

exclude from the diet irritant products (alcohol, coffee, smoked, pickled vegetables, seasonings,

marinades, extractives ), to limit the fat and carbohydrates (exclude sweets, flour and pasta).

For all types of hair loss in the diet it is desirable to include fresh vegetables (especially carrotsand cabbage), fruits (apples, apricots, dried apricots), as well as products containing gelatin

(jelly, Aspic and jellies), sea kale, must address functional disorders of the nervous and

endocrine system, digestive tract, liver, kidneys, foci of chronic infection, helminthic invasion,contributing to the development of alopecia.

Onychite

Onychite - nail infections and nail ridges (paronychia) of various origins can be congenital

or acquired.


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Most often found onihodistrofii (thinning, brittleness of nails, discoloration and the surface of

nail plate). This nail plate may lyse in the distal (oniholizis) or, conversely, to lengthen, thicken

by hyponychial keratoses and remind claw birds, hardly yielding to circumcision ( onihogrifoz).

Changes in nails of this kind may be in psoriasis, lichen planus, ichthyosis, keratoderma, blisters

epidermolize etc.With neuritis, leprosy, scleroderma, alimentary intoxication, hypovitaminosisdystrophic nail changes are largely associated with the violation of the trophic.

Often the nail plate affected by pathogenic fungi (trihofitony, candida, etc.) that leads to

thickening, loss of transparency of the nail, the appearance of yellow nail plate

(onychomycosis).

Hyperhidrosis

Hyperhidrosis - increased sweating as a result of hypersecretion of sweat glands. There

are general and l ocali zed hyperh idrosis.

Total hyperhidrosis observed when the high temperature environment, the physical and

emotional stress (physiological hyperhidrosis), as well as a number of diseases (tuberculosis,rheumatism, diabetes, thyrotoxicosis), lesions of the nervous system. The most common form of

localized hyperhidrosis -palmar-plantar hyperhidrosis and hyperhidrosis larger folds.Oftenthese forms - the manifestation of vascular dystonia, flat feet, as well as the result of non-

compliance with personal hygiene, use of close, rubber footwear, clothing made from synthetic

fabrics, etc. hyperhidrosis creates conditions for the development of fungal and pyogenic flora as

a result of maceration of the skin, changing its pH.Hyperhidrosis can be accompanied by anunpleasant fetid smell (bromidrosis), have staining properties(chromhidrosis), delivering patientunpleasant emotional feelings.

Treatment: identify and address factors contributing to the development of hyperhidrosis.Assignsedatives (valerian, Leonurus, drugs bromine), belloid, calcium preparations, the infusion of sage

(150-200 ml) inside.Outwardly use common warm baths with herbs (sage, sequence,Chamomile), for the palms and soles - alternating hot and cold baths with medicinal decoctions

drop caps, leaves, walnut, sage, oak bark. In between the toes and fingers, good sleep powder:

talc 50 g, 25 g of zinc oxide, burnt alum, 2 g, 25 g lemon essence, the skin of hands and feetrubbed with 1-10% alcohol solution of formalin (alternate with emollient creams for hands and

feet), use foot powder with hexamine (methenamine oxide zinc, talc - 10 g) alcohol solution (30

g of formalin, alum 0.5 g of ethyl alcohol 96% 90 ml, 1 g hexamine) and others should be careful

personal hygiene, drinking water treatment.

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21 Disease of Skin Appendages